Okay, it's twenty questions time. But we're going to ask you the questions. Do you know
what drugs are being used by people today and what those drugs can do to you? Test yourself
and find out what you know. You may be surprised by some of the answers!

1. The most commonly abused drug in the United States is:

omarijuana
oalcohol
ococaine
oheroin

2. Most drug users make their first contact with illicit drugs:

othrough drug dealers
othrough friends oaccidentally
oon their own

3. More people die each year in the U.S. as a result of:

oalcohol
otobacco
oheroin
ococaine

4. The majority of inhalant users are

omen
ochildren
owomen
othe elderly

5. Marijuana in small amounts is legal in the United States.

otrue
ofalse

6. Marijuana is much stronger today than it was 10 years ago.

otrue
ofalse

7. Marijuana can stay in the body up to:

o2dayso1week
o1 month

8. The use of alcohol and other drugs during pregnancy:

oshould stop after12 weeks
ois a risk at anypoint
oin small doses is not arisk

9. LSD is a hallucinogen.

otrue
ofalse

10. A shot of hard liquor contains the same amount of pure alcohol as a can of beer.

otrue ofalse

11. One must be _____ years old to legally purchase cigarettes.

o18
o20
o21

12. One must be _____ years old to legally purchase alcohol.

o20
o21
o19

13. A cold shower or a cup of black coffee will sober up a person that has been drinking.

otrue
ofalse

14. More teenage males drink alcohol than teenage females.

otrue
ofalse

15. The chemical in marijuana that causes the high is:

onicotine
oTHC
oMDMA

16. A blunt is marijuana in a:

ocigarette
ocigar
opipe

17. Crack is one of the most addictive drugs available today.

otrue
ofalse

18. The high from a typical dose of crack lasts:

o1 hour o30
minutes
o5 minutes

19. PCP is also known as:

oacid
osmack
oangeldust
oludes

20. Physical dependence can involve painful withdrawal symptoms when the drug is no longer
being used.

otrue
ofalse

Source: The Amercian Council for Drug Education

Answers to the Drug Awareness Quiz

1. The most commonly abused drug in the U.S. is:

oalcohol

2. Most drug users make their first contact with illicit drugs:

othrough friends

3. More people die each year in the U.S. as a result of:

otobacco

4. The majority of inhalant users are:

ochildren

5. Marijuana in small amounts is legal in the U.S.

ofalse

6. Marijuana is much stronger today than it was 10 years ago.

otrue

7. Marijuana can stay in the body up to:

o1 month

8. The use of alcohol and other drugs during pregnancy:

ois a risk at any point

9. LSD is a hallucinogen

otrue

10. A shot of hard liquor contains the same amount of pure alcohol as a can of beer.

otrue

11. One must be ______ years old to legally purchase cigarettes.

o18

12. One must be ______ years old to legally purchase alcohol.

o21

13. A cold shower or a cup of black coffee will sober up a person that has been drinking.

ofalse

14. More teenage males drink alcohol than teenage females.

otrue

15. The chemical in marijuana that causes the high is:

oTHC

16. A blunt is marijuana in a :

ocigar

17. Crack is one of the most addictive drugs available today.

otrue

18. The high from a typical dose of crack lasts:

o5 minutes

19. PCP is also known as:

oangel dust

20. Physical dependence can involve painful withdrawal symptoms when the drug is no longer
being used.

otrue

Source: The American Council for Drug Education

v A Self-Test for Cocaine Addiction

1. Do you ever use more cocaine than you planned?

2. Has the use of cocaine interfered with your job?

3. Is your cocaine use causing conflict with your spouse or family?

4. Do you feel depressed, guilty, or remorseful after you use cocaine?

5. Do you use whatever cocaine you have almost continuously until the supply is exhausted?

6. Have you ever experienced sinus problems or nosebleeds due to cocaine use?

7. Do you ever wish that you had never taken that first line, hit, or injection of cocaine?

8. Have you experienced chest pains or rapid or irregular heartbeats when using cocaine?

9. Do you have an obsession to get cocaine when you don't have it?

10. Are you experiencing financial difficulties due to your cocaine use?

11. Do you experience an anticipation high just knowing you are about to use cocaine?

12. After using cocaine, do you have difficulty sleeping without taking a drink or another drug?

13. Are you absorbed with the thought of getting loaded even while interacting with a friend or
loved one?

14. Have you begun to use drugs or drink alone?

15. Do you ever have feelings that people are talking about you or watching you?

16. Do you use larger doses of drugs or alcohol to get the same high you once experienced?

17. Have you tried to quit or cut down on your cocaine use only to find that you couldn't?

18. Have any of your friends or family suggested that you may have a problem?

19. Have you ever lied to or misled those around you about how much or how often you use?

20. Do you use drugs in your car, at work, in the bathroom, on airplanes, or other public
places?

21. Are you afraid that if you stop using cocaine or alcohol your work will suffer or you will
lose your energy, motivation, or confidence?

22. Do you spend time with people or in places you otherwise would not be around but for the
availability of drugs?

23. Have you ever stolen drugs or money from friends or family?

If you have answered Yes to any of these questions, you may have a cocaine problem.

Since the early 1960s, there has been an alarming increase in drug use in the United States.
In 1962, four million Americans had tried an illegal drug. By 1999, that number had risen to
a staggering 87.7 million, according to the 1999 National Household Survey on Drug
Abuse. The study also found that the number of illicit drug users who were above the age of 12
and had used drugs in the past month reached a high of 25.4 million in 1979, decreased through
the late 1980s to a low of 12 million in 1992, and has since increased to 14.8 million in 1999.

Some of the drugs currently being used are considerably more potent than they were in
the past. For example, while the average THC (delta-9-tetrahydrocannabinol, the
psychoactive ingredient) content of marijuana in the 1970s was 1.5 percent, it now averages 7.6
percent. Likewise, the purity of heroin has increased significantly. Until recently, heroin purity
levels ranged from one to ten percent. Now, the national average purity of heroin is 35
percent. South American heroin, which is available in many East Coast cities, ranges from 70 to
80 percent pure.

Drug use among teens, and even younger children, has been steadily increasing for the
past several years. According to the 1998 National Center on Addiction and Substance
Abuse survey, teen marijuana use is up almost 300 percent since 1992. In 1999, 55 percent of
high school seniors reported having used an illicit drug, while just seven years ago, only 41
percent said they had, according to the Monitoring the Future Study. Between 1991 and 1999,
illicit drug use among younger children, 13 and 14 year-olds, increased by 51 percent, from
18.7 percent to 28.3 percent.

There is another disturbing trend in the attitude many kids have towards illegal drugs.
According to a Partnership for a Drug-Free America survey, kids today are far more naive about
the dangers of drugs than they were at the beginning of the decade. For example, the survey
found that 72 percent of teenagers in 1990 viewed marijuana as harmful. Last year, that
number dropped to 54 percent. When young people think drugs are harmless, drug use
increases dramatically. This correlation is clearly illustrated by the recent rise in marijuana use.

While most Americans are aware that drug use in the United States is becoming more
prevalent among our younger citizens, many do not realize the profound impact that this drug
epidemic has on the country as a whole. Widespread drug use results in a less efficient, less
productive workforce. According to a Substance Abuse and Mental Health Services
Administration survey, employees who test positive for drug use make more than twice as many
workers' compensation claims, use almost twice the medical benefits, and take one-third more
leave time as non-users. They are also 60 percent more likely to be responsible for accidents.
The Office of National Drug Control Policy (ONDCP) estimates that the monetary cost of
illegal drug use to society is $110 billion a year.

In addition, drug-related violence and crime pose a grave, and much more direct threat to
the United States. According to the 1999 Arrestee Drug Abuse Monitoring Program, 75
percent of the male adults arrested in New York City for committing a violent crime tested positive
for drug use. The report also showed that in smaller cities like Albuquerque, New Mexico, and
Ft. Lauderdale, Florida, these figures ranged as high as 64 percent.

The drug epidemic is also taking a toll on the very core of American society_the family. According to the ONDCP's 1998 National Drug Control Strategy, drug use causes
violence and abuse within families:

 One-quarter to one-half of all incidents of domestic violence are drug-related.

 A survey of state child welfare agencies found substance abuse to be one of the key
problems exhibited by 81 percent of the families reported for child maltreatment.

These statistics, while alarming, reflect only the physical effects of drug abuse, and
therefore, show only a small portion of the suffering endured by American families as a result of
drugs. Emotional abuse, as well as financial strain on families, are other unfortunate symptoms of
drug abuse.

v Alcohol, Tobacco, and Other Drugs in the Workplace

"I guess you could call me a thiefI was stealing time from the
company." Anonymous small business employee recovering from chemical
dependency.[1]

Workplace alcohol-, tobacco-, and other drug- (ATOD) related problems cost U.S.
companies over $100 billion each
year.[2] Yet the workplace often has not been used optimally
for prevention of these problems. Given that a large majority of the adult population of the
United States is employed, the workplace is one of the most effective ways to reach adult
Americans and, in turn, their families and communities.

What's in it for business? Studies show that alcohol and other drug users:

 Are far less productive.[1]

 Use three times as many sick
days.[3]

 Are more likely to injure themselves or someone
else.[1]

 Are five times more likely to file worker's compensation
claims.[3]

And there are other worksite-related ATOD problems:

 A 1991 survey questioning heavy alcohol drinkers and current illicit drug users found
that 9 percent of heavy drinkers and 10 percent of drug users had missed work be
cause of a hangover in the past year, 6 percent of heavy drinkers and 15 percent of
drug users had gone to work high or drunk in the past year, and 11 percent of heavy
drinkers and 18 percent of drug users had skipped work in the past
month..[4]

 Approximately 70 percent of all illegal drug users are currently
employed.[5]

 Up to 40 percent of industrial fatalities can be linked to alcohol consumption and
alcoholism.[3]

 Family members of substance-abusing employees generally have higher than average
health care claims.

 Over their lifetime cigarette smokers cost approximately $10,000 more in medical
expenditures than do
nonsmokers.[6]

The establishment of alcohol-, tobacco-, and other drug-free workplaces is a critical
component of our nation's efforts to reduce the problems associated with substance abuse.
The workplace is the only place that can set a standard of no substance use for employees that
is tied to an economic incentivea paycheck.

All statistics cited in this chapter came from the following sources:

1. What Works: Workplaces Without Drugs, U.S. Department of Labor, 1991.

2. Working Partners: Confronting Substance Abuse in Small Business, National Conference Proceedings
Report, U.S. Department of Labor, 1992.

3. NCADD Fact Sheet: Alcohol and Other Drugs in the Workplace, National Council on Alcoholism and
Drug Dependence, Inc., May 1992.

4. Institute for Health Policy, Brandeis University, Substance Abuse: The Nation's Number One Health
Problem, Key Indicators for Policy, The Robert Wood Johnson Foundation, October 1993.

5. U.S. Department of Health and Human Services, National Institute on Drug Abuse, National
House hold Survey on Drug Abuse, 1991.

More than 70 percent of substance abusers hold jobs; one worker in four, ages 18 to 34,
used drugs in the past year; and one worker in three knows of drug sales in the workplace.

Americans consume 60 percent of the world's production of illegal drugs: 23 million
use marijuana at least four times a week; 18 million abuse alcohol; 6 million regularly use
cocaine; and 2 million use heroin.

In the workplace, the problems of these substance abusers become your problems.
They increase risk of accident, lower productivity, raise insurance costs, and reduce profits.
They can cost you your job; they can cost you your life.

What is substance abuse?

Men and women dependent on heroin, cocaine, or crackwho must have these potent
drugs to get through the dayare clearly substance abusers. And drug dependency takes more
than one form. You need not be physically addicted (and suffer painful bodily symptoms of
withdrawal when denied your drug of choice) to be drug dependent. Psychological dependency
is equally responsible for compulsive drug use.

But substance abuse covers a range of behavior that goes far beyond dependency. Abuse
may involve regular marijuana use, heavy drinking, weekend binges, casual consumption of
tranquilizers, or misuse of other prescription drugs. It includes any use of drugs or alcohol that
threatens physical or mental health, inhibits responsible personal relationships, or diminishes
the ability to meet family, social, or vocational obligations.

Does it threaten jobs?

Substance abusers don't have to indulge on the job to have a negative impact on the
workplace. Compared to their non- abusing coworkers, they are:

 ten times more likely to miss work

 3.6 times more likely to be involved in on-the-job accidents (and five times more likely
to injure themselves or another in the process)

 five times more likely to file a worker's compensation claim

 33 percent less productive

 responsible for health care costs that are three times as high

Operating machinery under the influence of alcohol or drugs is clearly high-risk. But
danger also increases when reflexes or judgment are compromised to any degree by drugs or
alcohol. And substance abusers are not only five times more likely than other workers to cause
injuries, they are also responsible for 40 percent of all industrial fatalities.

Working at minimal capacity, these workers increase the workloads of others, lower
productivity, compromise product quality, and can tarnish a company's image. Their absences and
health care demands raise costs. They reduce competitiveness and profitability, weakening the
companies that employ them and threatening everyone's job security.

What are the signs of abuse?

Substance abusers in the workplace can be difficult to identify. But there are some clues
that signal possible drug and alcohol problems.

Marijuana users may have bloodshot or glassy eyes and a persistent cough.

Cocaine users display increased energy and enthusiasm early in their drug involvement.
Later they may be subject to extreme mood swings and can become paranoid or delusional.

Alcohol abusers find it hard to conceal morning-after hangovers. Their productivity
declines, and they may show signs of physical deterioration.

How can it be prevented?

A comprehensive drug-free workplace program may be the best means of preventing,
detecting, and dealing with substance abusers.

Such a program generally includes the following elements:

 A written policy that is supported by top management, understood by a all employees,
consistently enforced, and perfectly clear about what is expected of employees and the
consequences of policy violations

 A substance abuse prevention program with an employee drug education component
that focuses not only on the dangers of drug and alcohol use but also on the availability
of counseling and treatment

 An appropriate drug and alcohol testing component, designed to prevent the hiring of
workers who use illegal drugs andas part of a comprehensive programprovide early
identification and referral to treatment for employees with drug or alcohol problems

 An Employee Assistance Program (EAP)

Employee Assistance Programs that provide counseling for employees and their family
members are structured to help workers with a wide range of problems. Substance abuse is
a primary concern. Working with substance abusers, EAP professionals seek to provide
whatever assistance makes it possible for employees to remain on or return to the job.
Many companies offer counseling and treatment services or refer employees to services in the
community. It is sometimes necessary for workers to take time off for treatment. In these
cases, successful completion of a rehabilitation program generally brings the former substance
abusers back to the workforce.

What can you do?

Substance abusers in the workplace create a problem that affects you and should concern
you. There are a number of ways in which you can do something about it.

uDon't be an "enabler."

When you cover up for substance abusers, lend them money, or help conceal poor
work performance, you are protecting them from the consequences of their behavior. You are
making it possible for them to continue abusing drugs or alcohol. You may think you're being a
friend, but you are doing them no favor.

u Don't "look the other way."

If you suspect drugs are being used or being sold, you should pass the word to a supervisor
or to security or human resources personnel. Such contacts are confidential and, in many
organizations, this information can be conveyed anonymously.

uDon't intervene on your own.

Drug abuse and drug dealing are serious problems that should be handled by qualified
professionals. Don't worry about jeopardizing a substance abuser's job.

Employees are often reluctant to let management know when they suspect drug activity,
worried that any coworkers they identify will be penalized or even lose their jobs. The reality
is that you place a co-worker in far greater jeopardy when you don't report your concern and,
in that way, make continued drug use possible.

Bear in mind that the threat of being fired often provides a potent deterrent to substance
abuse and will prompt many drug- and alcohol-troubled workers to accept help when they
had previously ignored the pleas of family and friends. Faced with the possibility of losing
their jobs, workers who had refused to recognize or acknowledge their substance abuse are
often motivated to enter treatment andwhat may be even more importantremain in
treatment long enough to make fundamental changes in attitudes and behavior.

The personal lives of employees profoundly affect on-the-job performance. A happy,
balanced home life extends into the workplace, encouraging both enthusiasm and high quality work.
On the other hand, personal concerns, particularly if they are severe and extended over time,
can have just the opposite effect, rendering an employee tense, depressed, unfocused and
often unable to fulfill job responsibilities.

A child with a drug or a drinking problem places an employee in this latter category.
And, because substance abuse among youth is intensifying and occurring at younger and
younger ages, employers increasingly must grapple with this problem. Failure to assist not only
diminishes the value of troubled employees, but it also can reduce, profitability and morale
affecting entire offices, shops and factory floors as other staff members try both to help and to take
up the slack for the affected individual.

Source: The American Council for Drug Education

v Sex Under the Influence of Alcohol and Other Drugs

Alcohol and other drug use is linked to risky sexual behavior and poses significant threats
to the health of adolescents. Substance abuse may impair adolescents' ability to make
judgments about sex and contraception, placing them at increased risk for unplanned pregnancy,
sexual assault, or becoming infected with a sexually transmitted disease (STD), including HIV/AIDS.

We know the AIDS virus can be transmitted through sharing hypodermic needles. Less
is known about the dangerous role of alcohol and other drugs in sexual behavior that may lead
to STDs and HIV/AIDS. To compound matters, there is also considerable evidence that
alcohol and other drugs weaken the immune system, thereby increasing susceptibility to infection
and disease.

Consider the following statistics:

 The use of alcohol and other drugs can affect judgment and lead to taking serious
sexual risks. There were 18,540 cases of AIDS among 13- to 24-year-olds reported
to the Centers for Disease Control and Prevention by the end of
1994.[1]

 About 75 percent of high school seniors have had sexual intercourse at least once in
their lives; about 20 percent have had more than four sexual partners by their senior
year.[2]

 Studies show that adolescents are less likely to use condoms when having sex after
drinking alcohol than when sober. This places them at even higher risk for HIV infection, STDs, and unwanted
pregnancy.[3]

 A survey of high school students found that 18 percent of females and 39 percent of
males say it is acceptable for a boy to force sex if the girl is stoned or
drunk.[4]

 According to the Centers for Disease Control and Prevention, HIV/AIDS has been the
sixth leading cause of death among 15- to 20-year-olds in the United States for over
three years. One in five of the new AIDS cases diagnosed is in the 20 to 29 year age
group, meaning that HIV transmission occurred during the teen years. Additionally,
more than half of new cases of HIV infection in 1994 were related to drug
use.[2]

There is still much to be learned about the relationship between alcohol and other drugs
and sexual behavior. During the past decade, teens reported higher levels of sexual activity
at earlier ages, experienced more unplanned pregnancies, and suffered higher rates of
sexually transmitted diseases. To reduce the incidence of these problems in the future, prevention
of alcohol and other drug abuse must be a top priority.

2. Centers for Disease Control and Prevention,
HIV/AIDS Prevention, Facts About: Adolescents and
HIVAIDS, December 1994.

3. Strunin, L., and Hingson, R. Alcohol Use and Risk for HIV Infection,
Alcohol and Health Research World Vol. 17, No. 1, National Institute on Alcohol Abuse and Alcoholism.

4. Inspector General, U.S. Department of Health and Human Services,
Youth and Alcohol: Dangerous and Deadly Consequences: Report to the Surgeon
General, April 1992.

Source: National Clearinghouse for Alcohol and Drug Abuse Information

v Violence and Crime & Alcohol and Other Drugs

"In both animal and human studies, alcohol, more than any other drug, has been
linked with a high incidence of violence and
aggression." Seventh Special Report to the
U.S. Congress on Alcohol and Health (Secretary of Health and Human Services, January 1990)

Crime is inextricably related to alcohol and other drugs (AOD). More than 1.1 million
annual arrests for illicit drug violations, almost 1.4 million arrests for driving while intoxicated,
480,000 arrests for liquor law violations and 704,000 arrests for drunkenness come to a total of
4.3 million arrests for alcohol and other drug statutory crimes. That total accounts for over
one-third of all arrests in this country.[1,2]

The impaired judgment and violence induced by alcohol contribute to alcohol-related
crime. Rapes, fights, and assaults leading to injury, manslaughter, and homicide often are linked
with alcohol because the perpetrator, the victim, or both, were drinking. The economic cost
of AOD-related crime is $61.8 billion
annually.[3]

Many perpetrators of violent crime were also using illicit drugs. Some of these drugs, such
as PCP and steroids, may induce violence. These drugs can also be a catalyst for
aggressive-prone individuals who exhibit violent behavior as a result of taking them.

The need for preventing alcohol and other drug problems is clear when the following
statistics are examined:

 Alcohol is a key factor in up to 68 percent of manslaughters, 62 percent of assaults, 54
percent of murders/attempted murders, 48 percent of robberies, and 44 percent of
burglaries.[4]

 Among jail inmates, 42.2 percent of those convicted of rape reported being under the
influence of alcohol or alcohol and other drugs at the time of the
offense.[5]

 Over 60 percent of men and 50 percent of women arrested for property crimes
(burglary, larceny, robbery) in 1990, who were voluntarily tested, tested positive for
illicit drug use.[2]

 In 1987, 64 percent of all reported child abuse and neglect cases in New York City
were associated with parental AOD
abuse.[6]

We cannot put a monetary value on the human lives and suffering associated with alcohol
and other drug problems. But we know the child welfare and court costs needed to deal with
the consequences of these problems are substantial. The cost to arrest, try, sentence, and
incarcerate those found guilty for these 4.3 million alcohol- and other drug-related offenses is a
tremendous drain on our nation's resources.

All statistics cited in this chapter came from the following sources:

1. U.S. Department of Justice, Bureau of Justice Statistics, Crime in the United States 1991, Washington,
DC, 1992.

2. U.S. Department of Justice, Bureau of Justice Statistics, Drugs, Crime, and the Justice System: A
National Report, Washington, DC, 1992.

3. Institute for Health Policy, Brandeis University, Substance Abuse: The Nation's Number One Health
Problem: Key Indicators for Policy. The Robert Wood Johnson Foundation, October 1993.

4. U.S. Department of Health and Human
Services, National Institute on Alcohol abuse and Alcoholism,
Alcohol and Health: Sixth Special Report to Congress on Alcohol and Health from the Secretary of
Health and Human Services, 1987.

"Alcohol is associated with a substantial proportion of human violence, and
perpetrators are often under the influence of alcohol. "
Eighth Special Report to the U.S. Congress on Alcohol and Health (Secretary of Health and Human Services, September 1993)

Studies of domestic violence frequently document high rates of alcohol and other drug (AOD)
involvement, and AOD use is known to impair judgment, reduce inhibition, and
increase aggression. Alcoholism and child abuse, including incest, seem tightly intertwined as well.
The connection between child abuse and alcohol abuse "may take the form of alcohol abuse
in parents or alcohol intoxication at the time of the abuse
incident."[1] Not only do abusers tend
to be heavy drinkers, but those who have been abused stand a higher probability of
abusing alcohol and other drugs over the course of their lifetime.

Alcohol consistently "emerges as a significant predictor of marital
violence."[2] Alcoholic women have been found to be significantly more likely to have experienced negative
verbal conflict with spouses than were nonalcoholic women. They were also significantly more
likely to have experienced a range of moderate and severe physical violence.

Studies have shown a significant association between battering incidents and alcohol
abuse. Further, a dual problem with alcohol and other drugs is even more likely to be associated
with the more severe battering incidents than is alcohol abuse by itself. The need for
preventing alcohol and other drug problems is clear when examining the following statistics are examined:

 In 1987, 64 percent of all reported child abuse and neglect cases in New York City
were associated with parental AOD
abuse.[3]

 A study of 472 women by the Research Institute on Addictions in Buffalo, NY, found
that 87 percent of alcoholic women had been physically or sexually abused as children,
compared to 59 percent of the nonalcoholic women surveyed (Miller and Downs,
1993).[4]

 A 1993 study of more than 2,000 American couples found rates of domestic violence
were almost 15 times higher in households where husbands were described as often
drunk as opposed to never
drunk.[5]

 Battered women are at increased risk of attempting suicide, abusing alcohol and other
drugs, depression, and abusing their own
children.[6]

 Alcohol is present in more than 50 percent of all incidents of domestic
violence.[5]

While alcohol and other drug use is neither an excuse for nor a direct cause of family
violence, several theories might explain the relationship. For example, women who are abused often
live with men who drink heavily, which places the women in an environment where their
potential exposure to violence is higher.

A second possible explanation is that women using alcohol and other drugs may not
recognize assault cues and even if they do, may not know how to respond appropriately. Third,
alcohol and other drug abuse by either parent could contribute to family violence by
exacerbating financial problems, child-care difficulties, or other family stressors.

Finally, the experience of being a victim of parental abuse could contribute to future
alcohol and other drug abuse.

Cocaine is a powerfully addictive stimulant that
directly affects the brain. Cocaine has been labeled the drug of
the 1980s and '90s, because of its extensive popularity
and use during this period. However, cocaine is not a
new drug. In fact, it is one of the oldest known drugs. The
pure chemical, cocaine hydrochloride, has been an
abused substance for more than 100 years, and coca leaves,
the source of cocaine, have been ingested for thousands
of years.

Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which
grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the
main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety
of illnesses. Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse,
but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for
some eye, ear, and throat surgeries.

There are basically two chemical forms of cocaine: the hydrochloride salt and the
"freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when
abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a
compound that has not been neutralized by an acid to make the hydrochloride salt. The
freebase form of cocaine is smokable.

Cocaine is generally sold on the street as a fine, white, crystalline powder, known as
"coke," "C," "snow," "flake," or "blow." Street dealers generally dilute it with such inert substances
as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a
chemically-related local anesthetic) or with such other stimulants as amphetamines.

What is crack?

Crack is the street name given to the freebase form of cocaine that has been processed
from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers
to the crackling sound heard when the mixture is smoked. Crack cocaine is processed
with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the
hydrochloride.

Because crack is smoked, the user experiences a high in less than 10 seconds. This
rather immediate and euphoric effect is one of the reasons that crack became enormously popular
in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.

In 1997, an estimated 1.5 million Americans (0.7 percent of those age 12 and older)
were current cocaine users, according to the 1997 National Household Survey on Drug
Abuse (NHSDA). This number has not changed significantly since 1992, although it is a
dramatic decrease from the 1985 peak of 5.7 million cocaine users(3 percent of the population).
Based upon additional data sources that take into account users underrepresented in the NHSDA,
the Office of National Drug Control Policy estimates the number of chronic cocaine users at
3.6 million.

Adults 18 to 25 years old have a higher rate of current cocaine use than those in any other
age group. Overall, men have a higher rate of current cocaine use than do women. Also,
according to the 1997 NHSDA, rates of current cocaine use were 1.4 percent for African
Americans, 0.8 percent for Hispanics, and 0.6 percent for Caucasians.

Crack cocaine remains a serious problem in the United States. The NHSDA estimated
the number of current crack users to be about 604,000 in 1997, which does not reflect any
significant change since 1988.

The 1998 Monitoring the Future Survey, which annually surveys teen attitudes and recent
drug use, reports that lifetime and past-year use of crack increased among eighth graders to
its highest levels since 1991, the first year data were available for this grade. The percentage
of eighth graders reporting crack use at least once in their lives increased from 2.7 percent
in 1997 to 3.2 percent in 1998. Past-year use of crack also rose slightly among this
group, although no changes were found for other grades.

Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related
emergency room visits, after increasing 78 percent between 1990 and 1994, remained level
between 1994 and 1996, with 152,433 cocaine-related episodes reported in 1996.

How is cocaine used?

The principal routes of cocaine administration are oral, intranasal, intravenous, and
inhalation. The slang terms for these routes are, respectively, "chewing," "snorting," "mainlining,"
"injecting," and "smoking" (including freebase and crack cocaine). Snorting is the process of
inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through
the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens
the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into
the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also
be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in
a "speedball."

Cocaine use ranges from occasional use to repeated or compulsive use, with a variety
of patterns between these extremes. There is no safe way to use cocaine. Any route of
administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular
or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by
any route of administration can produce addiction and other adverse health consequences.

How does cocaine produce its effects?

A great amount of research has been devoted to understanding the way cocaine produces
its pleasurable effects, and the reasons it is so addictive. One mechanism is through its effects
on structures deep in the brain. Scientists have discovered regions within the brain that,
when stimulated, produce feelings of pleasure. One neural system that appears to be most
affected by cocaine originates in a region, located deep within the brain, called the ventral
tegmental area (VTA). Nerve cells originating in the VTA extend to the region of the brain known as
the nucleus accumbens, one of the brain's key pleasure centers. In studies using animals,
for example, all types of pleasurable stimuli, such as food, water, sex, and many drugs of
abuse, cause increased activity in the nucleus accumbens.

Cocaine in the brain - In the normal communication process, dopamine is released by a
neuron into the synapse, where it can bind with dopamine receptors on neighboring neurons.
Normally dopamine is then recycled back into the transmitting neuron by a specialized protein called
the dopamine transporter. If cocaine is present, it attaches to the dopamine transporter and
blocks the normal recycling process, resulting in a buildup of dopamine in the synapse which
contributes to the pleasurable effects of cocaine.

Researchers have discovered that, when a pleasurable event is occurring, it is accompanied
by a large increase in the amounts of dopamine released in the nucleus accumbens by
neurons originating in the VTA. In the normal communication process, dopamine is released by
a neuron into the synapse (the small gap between two neurons), where it binds with
specialized proteins (called dopamine receptors) on the neighboring neuron, thereby sending a signal
to that neuron. Drugs of abuse are able to interfere with this normal communication process.
For
example, scientists have discovered that cocaine blocks the removal of dopamine from
the synapse, resulting in an accumulation of dopamine. This buildup of dopamine causes
continuous stimulation of receiving neurons, probably resulting in the euphoria commonly reported
by cocaine abusers.

As cocaine abuse continues, tolerance often develops. This means that higher doses and
more frequent use of cocaine are required for the brain to register the same level of pleasure
experienced during initial use. Recent studies have shown that, during periods of abstinence
from cocaine use, the memory of the euphoria associated with cocaine use, or mere exposure
to cues associated with drug use, can trigger tremendous craving and relapse to drug use,
even after long periods of abstinence.

What are the short-term effects of cocaine use?

uIncreased energy

u
Decreased appetite

u
Mental alertness

u
Increased heart rate and blood pressure

uConstricted blood vessels

u
Increased temperature

uDialated pupils

Cocaine's effects appear almost immediately after a single dose, and disappear within a
few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user
feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight,
sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find
that the drug helps them to perform simple physical and intellectual tasks more quickly, while
others can experience the opposite effect.

The duration of cocaine's immediate euphoric effects depends upon the route of
administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the
shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to
30 minutes, while that from smoking may last 5 to 10 minutes.

The short-term physiological effects of cocaine include constricted blood vessels;
dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts
(several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic,
and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia,
or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some
users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances,
sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related
deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

What are the long-term effects of cocaine use?

u
Addiction

uIrritability and mood disturbances

uRestlessness

uParanoia

uAuditory hallucinations

Cocaine is a powerfully addictive drug. Once having tried cocaine, an individual may
have difficulty predicting or controlling the extent to which he or she will continue to use the
drug. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability
to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the
brain's reward system, and is either directly or indirectly involved in the addictive properties of
every major drug of abuse.

An appreciable tolerance to cocaine's high may develop, with many addicts reporting that
they seek but fail to achieve as much pleasure as they did from their first experience. Some
users will frequently increase their doses to intensify and prolong the euphoric effects. While
tolerance to the high can occur, users can also become more sensitive (sensitization) to
cocaine's anesthetic and convulsant effects, without increasing the dose taken. This increased
sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly
high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in
a full-blown paranoid psychosis, in which the individual loses touch with reality and
experiences auditory hallucinations.

What are the medical complications of cocaine abuse?

uCardiovascular effects

 disturbances in heart rhythm

 heart attacks

uRespiratory effects

 chest pain

 respiratory failure

uNeurological effects

 strokes

 seizures and headaches

uGastrointestinal complications

 abdominal pain

 nausea

There are enormous medical complications associated with cocaine use. Some of the
most frequent complications are cardiovascular effects, including disturbances in heart rhythm
and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological
effects, including strokes, seizure, and headaches; and gastrointestinal complications, including
abdominal pain and nausea. Cocaine use has been linked to many types of heart disease. Cocaine
has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate
heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms
may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.

Different routes of cocaine administration can produce different adverse effects.
Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems
with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to
a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due
to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks,"
most commonly in their forearms. Intravenous cocaine users may also experience an allergic
reaction, either to the drug, or to some additive in street cocaine, which can result, in severe
cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine
users lose their appetites and can experience significant weight loss and malnourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol.
Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has
a longer duration of action in the brain and is more toxic than either drug alone. While
more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the
most common two-drug combination that results in drug-related death.

Are cocaine abusers at risk for contracting HIV/AIDS and hepatitis B and C?

Yes. Cocaine abusers, especially those who inject, are at increased risk for contracting
such infectious diseases as human immunodeficiency virus (HIV/AIDS) and hepatitis. In fact,
use and abuse of illicit drugs, including crack cocaine, have become the leading risk factors for
new cases of HIV. Drug abuse-related spread of HIV can result from direct transmission of
the virus through the sharing of contaminated needles and paraphernalia between injecting
drug users. It can also result from indirect transmission, such as an HIV-infected mother
transmitting the virus prenatally to her child. This is particularly alarming, given that more than 60 percent
of new AIDS cases are women. Research has also shown that drug use can interfere with
judgement about risk-taking behavior, and can potentially lead to reduced precautions about
having sex, the sharing of needles and injection paraphernalia, and the trading of sex for drugs,
by both men and women.

Additionally, hepatitis C is spreading rapidly among injection drug users; current
estimates indicate infection rates of 65 to 90 percent in this population. At present, there is no
vaccine for the hepatitis C virus, and the only treatment is expensive, often unsuccessful, and may
have serious side effects.

What is the effect of maternal cocaine use?

The full extent of the effects of prenatal drug exposure on a child is not completely known,
but many scientific studies have documented that babies born to mothers who abuse cocaine
during pregnancy are often prematurely delivered, have low birth weights and smaller head
circumferences, and are often shorter in length.

Estimating the full extent of the consequences of maternal drug abuse is difficult, and
determining the specific hazard of a particular drug to the unborn child is even more problematic,
given that, typically, more than one substance is abused. Such factors as the amount and number
of all drugs abused; inadequate prenatal care; abuse and neglect of the children, due to
the mother's life-style; socio-economic status; poor maternal nutrition; other health problems;
and exposure to sexually transmitted diseases, are just some examples of the difficulty in
determining the direct impact of perinatal cocaine use, for example, on maternal and fetal outcome.

Many may recall that "crack babies," or babies born to mothers who used cocaine
while pregnant, were written off by many a decade ago as a lost generation. They were predicted
to suffer from severe, irreversible damage, including reduced intelligence and social skills. It
was later found that this was a gross exaggeration. Most crack-exposed babies appear to
recover quite well. However, the fact that most of these children appear normal should not be
over-interpreted as a positive sign. Using sophisticated technologies, scientists are now finding
that exposure to cocaine during fetal development may lead to subtle, but significant, deficits
later, especially with behaviors that are crucial to success in the classroom, such as blocking
out distractions and concentrating for long periods of time.

What treatments are effective for cocaine abusers?

There has been an enormous increase in the number of people seeking treatment for
cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the
country, except in the West and Southwest, report that cocaine is the most commonly cited drug
of abuse among their clients. The majority of individuals seeking treatment smoke crack, and
are likely to be poly-drug users, or users of more than one substance. The widespread abuse
of cocaine has stimulated extensive efforts to develop treatment programs for this type of
drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in
the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment
of cocaine addiction is complex, and must address a variety of problems. Like any good
treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and
pharmacological aspects of the patient's drug abuse.

– Pharmacological Approaches

There are no medications currently available to treat cocaine addiction specifically.
Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine
treatment medications. Several newly emerging compounds are being investigated to assess their
safety and efficacy in treating cocaine addiction. For example, one of the most promising
anti-cocaine drug medications to date, selegeline, is being taken into multi-site phase III clinical trials
in 1999. These trials will evaluate two innovative routes of selegeline administration: a
transdermal patch and a time-released pill, to determine which is most beneficial. Disulfiram, a
medication that has been used to treat alcoholism, has also been shown, in clinical studies, to be
effective in reducing cocaine abuse. Because of mood changes experienced during the early stages
of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In
addition to the problems of treating addiction, cocaine overdose results in many deaths every year,
and medical treatments are being developed to deal with the acute emergencies resulting
from excessive cocaine abuse.

– Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction,
including both residential and outpatient approaches. Indeed, behavioral therapies are often the
only available, effective treatment approaches to many drug problems, including cocaine
addiction, for which there is, as yet, no viable medication. However, integration of both types of
treatments is ultimately the most effective approach for treating addiction. It is important to
match the best treatment regimen to the needs of the patient. This may include adding to or
removing from an individual's treatment regimen a number of different components or elements.
For example, if an individual is prone to relapses, a relapse component should be added to
the program. A behavioral therapy component that is showing positive results in many
cocaine-addicted populations, is contingency management.

Contingency management uses a voucher-based system to give positive rewards for staying
in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn
points, which can be exchanged for items that encourage healthy living, such as joining a gym, or
going to a movie and dinner.

Cognitive-behavioral therapy is another approach. Cognitive-behavioral coping skills
treatment, for example, is a short-term, focused approach to helping cocaine-addicted
individuals become abstinent from cocaine and other substances. The underlying assumption is that
learning processes play an important role in the development and continuation of cocaine abuse
and dependence. The same learning processes can be employed to help individuals reduce
drug use. This approach attempts to help patients to recognize, avoid, and cope; i.e., recognize
the situations in which they are most likely to use cocaine, avoid these situations when
appropriate, and cope more effectively with a range of problems and problematic behaviors associated
with drug abuse. This therapy is also noteworthy because of its compatibility with a range of
other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities, or residential programs with planned lengths of stay of 6 to
12 months, offer another alternative to those in need of treatment for cocaine addiction.
Therapeutic communities are often comprehensive, in that they focus on the resocialization of the
individual to society, and can include on-site vocational rehabilitation and other supportive
services. Therapeutic communities typically are used to treat patients with more severe
problems, such as co-occurring mental health problems and criminal involvement.

Where can I get further scientific information about cocaine addiction?

To learn more about cocaine and other drugs of abuse, contact the National Clearinghouse
for Alcohol and Drug Information (NCADI) at 1-800-729-6686. Information specialists
are available to assist you in locating needed information and resources.

Fact sheets on the health effects of drug abuse and other topics can be ordered free of
charge, in English and Spanish, by calling NIDA INFOFAX at 1-888-NIH-NIDA
(1-888-644-6432), or for hearing impaired persons, 1-888-TTY-NIDA (1-888-889-6432).

Information can also be accessed through the NIDA World Wide Web site
(http://www.nida.nih.gov/) or the NCADI Web site (http://www.health.org/).

Glossary

Addiction: A chronic, relapsing disease, characterized by compulsive drug-seeking and
use and by neurochemical and molecular changes in the brain.

Anesthetic: An agent that causes insensitivity to pain.

Antidepressants A group of drugs used in treating depressive disorders.

Cocaethylene: Potent stimulant created when cocaine and alcohol are used together.

Coca: The plant, Erythroxylon, from which cocaine is derived. Also refers to the leaves of
this plant.

Crack: Short term for a smokable form of cocaine.

Craving: A powerful, often uncontrollable desire for drugs.

Dopamine: A neurotransmitter present in regions of the brain that regulate movement,
emotion, motivation, and the feeling of pleasure.

Neuron: A nerve cell in the brain.

Physical dependence: An adaptive physiological state that occurs with regular drug use
and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance.

Poly-drug user: An individual who uses more than one drug.

Rush: A surge of pleasure that rapidly follows administration of some drugs.

Tolerance: A condition in which higher doses of a drug are required to produce the
same effect as during initial use; often is associated with physical dependence.

Vertigo: The sensation of dizziness.

Withdrawal: A variety of symptoms that occur after use of an addictive drug is reduced
or stopped.

Numerous reports have suggested a rise in heroin use in recent years, which has been
attributed to young people who are smoking or sniffing rather than injecting. The purity of heroin
has increased to a level that makes smoking and sniffing feasible. The increased purity and
the concern about AIDS may be causing the shift from injecting to smoking and sniffing
among heroin users. This paper examines these issues in addition to examining the prevalence of
heroin use. It also describes the characteristics of heroin users and trends in heroin use.

Description of Heroin and Effects of Use

A narcotic derived from the opium poppy, heroin was originally developed as a substitute
for morphine in an effort to deal with the addiction problem. However, it was quickly
recognized that heroin is even more addictive than morphine. As a result the drug was made illegal.
Produced in Mexico and Asia, heroin is reported to be widely available throughout the U.S. At
the street level, heroin is "cut" with a variety of substances, leading to variation in purity over
time and in different areas. Estimates of the purity of heroin have shown substantial increases
between 1984 and 1995.3, 4

When injected, sniffed or smoked, heroin binds with opiate receptors found in many regions
of the brain. The result is intense euphoria, often referred to as a rush. The rush lasts only
briefly and is followed by a couple of hours of a relaxed, contented state. In large doses, heroin
can reduce or eliminate respiration. Withdrawal symptoms include: nausea, dysphoria,
muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection or sweating, diarrhea,
yawning, fever, and insomnia.

Prevalence of Heroin Use

Efforts to estimate the prevalence of heroin use have a long history with precise
estimates remaining difficult to determine. Standard methods of measuring prevalence such as
household surveys are not adequate. Since heroin use is rare in the general population, only a
small number of users would be included in a household survey. Survey based estimates
substantially underestimate prevalence because of difficulties in locating heroin abusers (e.g. many of
them are not living in stable households). In addition, because heroin use is an illegal activity,
heroin users may not accurately report their use.

Various studies using different methods for estimating heroin have produced a range of
estimates. Some of these studies combined data from more than one source. During the 1970s several
studies combined data on heroin from admissions to federally funded drug treatment programs,
hospital emergency room visits, heroin related deaths, retail price of heroin, and retail purity of heroin.
These studies provided a range of estimates of the number of heroin addicts. The estimates range
from 400,000 to 600,000 each year during the
1970s.10, 11 A recent study combining
household survey
and arrestee data estimated that there were 229,000 "casual" users and 500,000 "heavy"
users in 1993.12

Data from the 1996 National Household Survey on Drug Abuse (NHSDA)
conservatively show that there were approximately 2.4 million persons who used heroin at least once in
their lifetime and approximately 455 thousand people who used heroin at least once in the
past year.8 To partially account for underestimation by the NHSDA due to underreporting
and undercoverage, an adjustment based on counts of arrests and treatment data resulted in
estimates of 2.9 million lifetime users and 663 thousand past year
users.12

Characteristics of Heroin Users

Data from the NHSDA for the combined years of 1995 and 1996 indicated that 67% of
past year heroin users were male; 22% were 12-17 years old, and 21% were 35 years and
older; 69% were white, 21% were black, and 9% were Hispanic; 39% lived in a large
metropolitan area; 15% were college students in the past year who were 17-22 years of age. Among
adult heroin users, 41% had less than a high school education, and 33% worked full
time.13

Patterns of Use

There are some indications that a large proportion of heroin use involves heroin in
combination with other drugs, especially cocaine and alcohol. Ethnographers have reported that
"criss-crossing" (lines of cocaine and heroin are alternately inhaled) is becoming more common and
is gaining in popularity among cocaine users in New
York.1 They have also reported that
some users are snorting heroin and smoking crack in combination. In this combination, it is
believed that the primary drug is crack and heroin is used to ease agitation associated with
crack.2 Among heroin-related drug abuse deaths reported to DAWN in 1995, most (90%)
involved heroin in combination with other drugs, most often cocaine. Cocaine was reported in
combination with heroin in 1,933 deaths (46% of all heroin-related deaths). Alcohol was the next
most frequently reported drug in combination with heroin among drug abuse deaths reported
to DAWN. In 1995, 1,854 deaths (44% of all heroin-related deaths) involved heroin in
combination with alcohol.5

Trends in Heroin Use

Increases in use and consequences. Data also suggest that there has been a rise in heroin use
in recent years and that this rise has occurred among younger persons who are smoking
or sniffing heroin rather than injecting. Some indicators exhibit an overall rise in heroin use,
some display a rise in heroin use among youth, college students, and adolescents in small
metropolitan areas and others suggest that new users tend to smoke or sniff rather than inject. In
addition, there is some evidence that the time between first use of marijuana and first use of
heroin is decreasing

Ethnographers for "Pulse Check" continue to report that the majority of new users are
inhaling heroin rather than injecting
heroin.2 The purity of heroin and the fear of AIDS may be
responsible for the shift from injecting to smoking or sniffing heroin. The purity of heroin is
much higher than it was 10 years ago.

Since smoking or sniffing is less invasive than injecting heroin, it may be perceived
as less
risky. This may be a reason for the increase in new users of heroin, especially among the young,
and the decrease in the time between first use of marijuana and first use of heroin.

REFERENCES

1.Epidemiological Trends in Drug Abuse, Advance
Report, June, 1996, Community Epidemiology Work
Group, National Institute on Drug Abuse, National Institutes of Health, Public Health Service, DHHS.

2. "Pulse Check National Trends in Drug Abuse-Winter
1995," Office of National Drug Control Strategy.

11. Demaree, R.G., Hudiburg, R.A., Fletcher, B.W., Estimates of the Prevalence of Heroin Use in 24
Metropolitan Areas 1976-1979, National Institute on Drug Abuse, National Institutes of Health,
Public Health Service, Rockville, Maryland: U.S. Department of Health and Human Services

12.The National Drug Control Strategy: 1996, Executive Office of the President of the United States,
The White House.

13. Unpublished Data from the NHSDA

14. Unpublished Data from the DAWN

15. Advance Report Number 9A, Overview of the FY94 National Drug and Alcoholism Treatment Unit
Survey (NDATUS): Data From 1993 and
1980-1993Public Health Service, Rockville, Maryland: U.S.
Department of Health and Human Services.

Methamphetamine, or "meth," is a dangerous, sometimes lethal and unpredictable drug.
Meth is also known as speed, ice, and crystal. Like cocaine, meth is a potent central nervous
system stimulant. Meth represents the fastest growing drug threat in America today.

Meth can be smoked, snorted, injected, or taken orally, and its
appearance varies depending on how it is used. Typically, it is a white,
odorless, bitter-tasting powder that easily dissolves in water.
Another common form of the drug is crystal meth, or "ice," named for its
appearance (that of clear, large chunky crystals resembling rock
candy). Crystal meth is smoked in a manner similar to crack cocaine and
about 10 to 15 "hits" can be obtained from a single gram of the
substance. Users have referred to smoking ice as a "cool" smoke, while
the smoking of crack is a "hot" smoke. The euphoric effect of smoking
ice lasts longer than that of smoking crack.

Methamphetamine use increases the heart rate, blood pressure, body temperature, and rate
of breathing, and it frequently results in violent behavior in users. Meth also dilates the pupils
and produces temporary hyperactivity, euphoria, a sense of increased energy, and tremors.
High doses or chronic use have been associated with increased nervousness, irritability, and
paranoia. Withdrawal from high doses produces severe depression.

Chronic abuse produces a psychosis similar to schizophrenia and is characterized by
paranoia, picking at the skin, self absorption, and auditory and visual hallucinations. Violent and
erratic behavior is frequently seen among chronic, high-dose methamphetamine abusers. The
most dangerous stage of the binge cycle is known as "tweaking." Typically, during this stage,
the abuser has not slept in three to fifteen days and is irritable and paranoid. The tweaker has
an intense craving for more meth; however, no dosage will help recreate the euphoric high.
This causes frustration and leads to unpredictability and a potential for violence.

Use

The 1999 National Household Survey on Drug Abuse estimated that 9.4 million
Americans tried methamphetamine in their lifetime. This figure shows a marked increase from the 1994
estimate of 3.8 million.

v Marijuana

The flowering top of acannabis plant

Pharmacology

Marijuana is the most commonly used illicit drug in America
today. The term "marijuana" refers to the leaves and flowering tops of
the cannabis plant.

A tobaccolike substance produced by drying the leaves and
flowering tops of the cannabis plant, marijuana varies significantly in its
potency, depending on the source and selection of plant materials
used. Sinsemilla, which is derived from the unpollinated female
cannabis plant, and hashish, the resinous material of the cannabis plant,
are popular with users because of their high concentration of THC
(delta-9-tetrahydrocannabinol). THC is believed to be the chemical
responsible for most of the psychoactive effects of the plant.

Marijuana is usually smoked in the form of loosely rolled cigarettes called joints or
hollowed-out commercial cigars called blunts. Joints and blunts may be laced with a number of
adulterants including phencyclidine (PCP), substantially altering the effects and toxicity of
these products. Street names for marijuana include pot, grass, weed, mary jane, acupulco gold,
and reefer.

Although marijuana grown in the United States was once considered inferior because of its
low concentration of THC, advancements in plant selection and cultivation have resulted in
highly potent domestic marijuana. For example, the average THC content of
U.S.-produced sinsemilla has risen from 3.2 percent in 1977 to 12.8 percent in 1997.

Marijuana contains known toxins and cancer-causing chemicals that are stored in fat cells
of users for up to several months. Marijuana users experience the same health problems
as tobacco smokers, such as bronchitis, emphysema, and bronchial asthma. Some of the
effects of marijuana use also include increased heart rate, dryness of the mouth, reddening of the
eyes, impaired motor skills and concentration, and frequent hunger. Extended use increases risk
to the lungs and reproductive system, as well as suppression of the immune system.
Occasionally, hallucinations, fantasies, and paranoia are reported.

Use

Use among youth: The marijuana problem among youth is particularly acute. According to
a survey conducted by Phoenix House, an organization that runs drug abuse treatment
centers and conducts extensive research, marijuana was the drug of choice for 87 percent of
teens entering treatment programs in New York during the first quarter of 1999. A 1996
national survey conducted by Phoenix House revealed that eighty-three percent of adolescents
in treatment perceived, at one time or another, marijuana to be less dangerous than other
illicit drugs, and 60 percent agreed that using marijuana made it easier for them to consume
other drugs, including cocaine, methamphetamine, and LSD.

Availability

Marijuana is readily available throughout all metropolitan, suburban, and rural areas of
the continental United States.

v "Dangerous Drugs"

The DEA uses the term "dangerous drugs" to refer to broad categories or classes of
controlled substances other than cocaine, opiates, and cannabis products. These drugs are produced
in clandestine laboratories or are pharmaceutical products that are diverted from
legitimate handlers.

Many of these clandestinely manufactured drugs are known as controlled substance
analogues, which are chemicals that are designed to be "copies" of controlled substances in Schedule I
or II. These drugs produce stimulant, depressant, or hallucinogenic effects on users that
are similar to those produced by the Schedule I or II substances after which they are modeled.
The main difference between controlled substances and their analogues is that the controlled
substances have recognized medicinal value and can be legally manufactured for medicinal
use. The AntiDrug Abuse Act of 1986 established a category, Controlled Substance
Analogues, whereby any drug that meets the definition of controlled substance analogue is treated as if
it were a Schedule I controlled substance.

v Lysergic Acid Diethylamide (LSD)

Lysergic acid diethylamide (LSD) is the most potent
hallucinogen known to man. Itwas originally synthesized in 1938 by Dr.
Albert Hoffman, but its hallucinogenic effects were unknown until
1943, when Dr. Hoffman accidently consumed some LSD. Because of
its structural similarity to a chemical present in the brain and the
similarity of its effects to certain aspects of psychosis, LSD was used as
a research tool to study mental illness decades ago.

After a decline in its illicit use after its initial popularity in the 1960s, LSD made a comeback
in the 1990s. However, the current average oral dose consumed by users is 30 to 50
micrograms, a decrease of nearly 90 percent from the 1960 average dose of 250 to 300
micrograms. Lower potency doses probably account for the relatively few LSD-related
emergency incidents during the past several years and its present popularity among young people.

LSD is produced in crystalline form and then mixed with excipients or diluted as a liquid
for production in ingestible forms. Often, LSD is sold in tablet form (usually small tablets known
as microdots), on sugar cubes, in thin squares of gelatin (commonly referred to as
window panes), and most commonly, as blotter paper (sheets of paper soaked in or impregnated
with LSD, covered with colorful designs or artwork, and perforated into one-quarter inch
square, individual dosage units).

LSD is sold under more than 80 street names including
acid, blotter, cid, doses, and trips,
as well as names that reflect the designs on the sheets of blotter paper.

Physical reactions to LSD may include dilated pupils, lowered body temperature,
nausea, "goose bumps," profuse perspiration, increased blood sugar, and rapid heart rate. During
the first hour after ingestion, the user may experience visual changes with extreme changes
in mood. The user may also suffer impaired depth and time perception, with distorted
perception of the size and shape of objects, movements, color, sound, touch and the user's own
body image. Under the influence of LSD, the ability to make sensible judgments and see
common dangers is impaired, making the user susceptible to personal injury. He may also injure
others by attempting to drive a car or operating machinery. The effects of higher doses last for 10
to 12 hours. After an LSD "trip," the user may suffer acute anxiety or depression for a
variable period. Users may also experience "flashbacks," which are recurrences of the effects of
LSD, days or even months after taking the last dose.

v MDMA (Ecstasy)

MDMA (3, 4-Methylenedioxymethamphetamine) is a Schedule I synthetic, psychoactive
drug possessing stimulant and hallucinogenic properties. MDMA possesses chemical variations
of the stimulant amphetamine or methamphetamine and a hallucinogen, most often
mescaline. Commonly referred to as Ecstasy or XTC, MDMA was first synthesized in 1912 by a
German company possibly to be used as an appetite suppressant. Chemically, it is an analogue
of MDA, a drug that was popular in the 1960s. In the late 1970s, MDMA was used to
facilitate psychotherapy by a small group of therapists in the United States. Illicit use of the drug did
not become popular until the late 1980s and early 1990s. MDMA is frequently used in
combination with other drugs. However, it is rarely consumed with alcohol, as alcohol is believed
to diminish its effects. It is most often distributed at late-night parties called "raves,"
nightclubs, and rock concerts. As the rave and club scene expands to metropolitan and suburban
areas across the country, MDMA use and distribution are increasing as well.

MDMA is taken orally, usually in tablet or capsule form, and its effects last approximately
four to six hours. Users of the drug say that it produces profoundly positive feelings, empathy
for others, elimination of anxiety, and extreme relaxation. MDMA is also said to suppress the
need to eat, drink, or sleep, enabling users to endure two- to three-day parties.
Consequently, MDMA use sometimes results in severe dehydration or exhaustion. While it is not as
addictive as heroin or cocaine, MDMA can cause other adverse effects including nausea,
hallucinations, chills, sweating, increases in body temperature, tremors, involuntary teeth clenching,
muscle cramping, and blurred vision. MDMA users also report after-effects of anxiety, paranoia,
and depression. An MDMA overdose is characterized by high blood pressure, faintness,
panic attacks, and, in more severe cases, loss of consciousness, seizures, and a drastic rise in
body temperature. MDMA overdoses can be fatal, as they may result in heart failure or extreme
heat stroke.

The effects of long-term MDMA use are just beginning to undergo scientific analysis. In
1998, the National Institute of Mental Health conducted a study of a small group of habitual
MDMA users who were abstaining from use. The study revealed that the abstinent users
suffered damage to the neurons in the brain that transmit serotonin, an important biochemical involved
in a variety of critical functions including learning, sleep, and integration of emotion. The results
of the study indicate that recreational MDMA users may be at risk of developing permanent
brain damage that may manifest itself in depression, anxiety, memory loss, and other
neuropsychotic disorders.

v Phencyclidine (PCP)

In the 1950s, phencyclidine, more commonly known as PCP, was investigated as an
anesthetic but, due to the side effects of confusion and delirium, its development for human medical
use was discontinued. It became commercially available for use as a veterinary anesthetic in
the 1960s under the trade name of Sernylan and was placed in Schedule III of the
Controlled Substances Act (CSA). In 1978, due to considerable abuse of PCP, it was transferred
to Schedule II of the CSA, and commercial manufacturing of Sernylan was discontinued.
Today, all of the PCP encountered on the illicit market in the United States is produced in
clandestine laboratories.

PCP is illicitly marketed under a number of other names
including angel dust, supergrass, killer weed, embalming
fluid, and rocket fuel that reflect the range of its bizarre and volatile effects. In its
pure form, it is a white crystalline powder that readily dissolves in
water. However, most PCP on the illicit market contains a number of
contaminants as a result of makeshift manufacturing, causing the color
to range from tan to brown, and the consistency to range from
powder to a gummy mass.

The chemicals needed to manufacture PCP are readily available
and inexpensive, and the production process requires little formal
chemical knowledge or laboratory equipment. The drug is sold primarily
in urban neighborhoods in a limited number of U.S. cities. The
liquid form of PCP is actually PCP base dissolved most often in ether,
a highly flammable solvent. PCP typically is sprayed onto leafy
material such as marijuana, mint, oregano, or parsley, and smoked.

The drug's effects are as varied as its appearance. A
moderate amount of PCP often causes users to feel detached, distant, and estranged from their surroundings. Numbness,
slurred speech, and loss of coordination may be accompanied by a sense of strength and
invulnerability. A blank stare, rapid and involuntary eye movements, and an exaggerated gait are
among the more observable effects. Auditory hallucinations, image distortion, severe mood
disorders, and amnesia may also occur. In some users, PCP may cause acute anxiety and a feeling
of impending doom; in others, paranoia and violent hostility; and in some, it may produce
a psychoses indistinguishable from schizophrenia. Many believe PCP to be one of the
most dangerous drugs of abuse. Modification of the manufacturing process may yield
chemically related analogues capable of producing psychotic effects similar to PCP.

v Ketamine

Ketamine hydrochloride, known as special
k and k, is a general anesthetic for human
and veterinary use. Ketamine produces effects similar to PCP with the visual effects of LSD.
Users tout its trip as better than that of PCP or LSD because its overt hallucinatory effects are
short-acting, lasting an hour or less. The drug, however, can affect the senses, judgment, and
coordination for 18 to 24 hours. Ketamine sold on the streets comes from diverted legitimate
supplies, primarily veterinary clinics. Its appearance is similar to that of pharmaceutical
grade cocaine, and it is snorted, placed in alcoholic beverages, or smoked in combination
with marijuana. The incidence of ketamine abuse is increasing, and accounts of ketamine
abuse appear in reports of rave parties attended by teenagers. Ketamine was placed in Schedule
III of the Controlled Substance Act in August 1999.

vGamma Hydroxybutyrate (GHB)

Gamma Hydroxybutyrate (GHB), known as liquid x, Georgia home boy, Goop,
gamma-oh, and grievous bodily harm, is a central nervous system depressant abused for its ability
to produce euphoric and hallucinatory states and its alleged ability to release a growth
hormone and stimulate muscle growth. Although GHB was originally considered a safe and
"natural" food supplement and was sold in health food stores, the medical community soon
became aware that it caused overdoses and other health problems. GHB can produce
drowsiness, dizziness, nausea, unconsciousness, seizures, severe respiratory depression, and coma.
GHB can be found in liquid form or as a white powdered material. It is taken orally and is
frequently combined with alcohol.

Abusers include high school and college students and rave party attendees who use GHB
for its intoxicating effects. Some body builders also abuse GHB for its alleged anabolic
effects. Several cases have documented the use of GHB to incapacitate women for the commission
of sexual assault. In 1990, the Food and Drug Administration (FDA) issued an advisory
declaring GHB unsafe and illicit except under FDA-approved, physician-supervised protocols. In
March 2000, GHB was placed in Schedule I of the Controlled Substances Act.

v Methylphenidate (Ritalin®)

Methylphenidate, which is manufactured under the brand name Ritalin, is a Schedule II
stimulant that produces pharmacological effects similar to those of cocaine and amphetamine and
is prescribed by doctors to treat attention-deficit/hyperactivity disorder (ADHD) and
other conditions. Unlike other stimulants, however, methylphenidate (MPH) has not been
produced in clandestine labs. The dramatic increase in U.S. production and consumption of this drug
in recent years can largely be attributed to its increased use for the treatment of ADHD in
children.

A growing number of incidents of abuse have been associated with adolescents and
young adults who are using MPH for its stimulant effects: appetite suppression, wakefulness,
and increased focus/attentiveness (for long nights of studying), and euphoria. Pharmaceutical
tablets are most frequently taken orally or by crushing the tablets and snorting the powder.
However, some addicts dissolve the tablets in water and inject the mixture. Complications arising
from this practice are common due to the insoluble fillers used in the tablets. When injected,
these materials block small blood vessels, causing serious damage to the lungs and retina of the
eye. MPH also produces dose-related increases in heart rate and blood pressure and is capable
of producing severe psychological dependence.

vSteroids

During the past decade, anabolic steroid abuse became a national concern. These drugs
are used illicitly by weight lifters, body builders, long distance runners, cyclists, and others
who claim that these drugs give them a competitive advantage and/or improve their physical
appearance. Overall youth steroid use remains alarmingly high. According to the 1999 Monitoring
the Future Study, the percentage of eighth, tenth, and twelfth graders who reported using
steroids at least once in their lives has increased steadily over the past four years (an average of
1.8 percent in 1996, 2.1 percent in 1997, 2.3 percent in 1998, and 2.8 percent in 1999).
In addition, steroid use to enhance athletic performance is no longer limited to high school
males; a 1998 Pennsylvania State University study found that 175,000 high school girls
nationwide reported taking steroids at least once in their lifetime.

vFlunitrazepam (Rohypnol®)

Rophpnol Tablets

Flunitrazepam, which is marketed under the brand name Rohypnol and
is commonly known as roofies, belongs to the benzodiazepine class of
drugs. Flunitrazepam has never been approved for medical use in the
United States, therefore, doctors cannot prescribe it and pharmacists cannot
sell it. However, it is legally prescribed in over 50 other countries and is
widely available in Mexico, Colombia, and Europe where it is used for the
treatment of insomnia and as a pre-anesthetic. Therefore, it was placed
into Schedule IV of the Controlled Substances Act in 1984 due to
international treaty obligations and remains under that classification.

Like other benzodiazepines (such as Valium, Librium, Xanax, and Halcion),
flunitrazepam's pharmacological effects include sedation, muscle relaxation, reduction in anxiety, and
prevention of convulsions. However, flunitrazepam's sedative effects are approximately 7 to 10
times more potent than diazepam (Valium). The effects of flunitrazepam appear approximately 15
to 20 minutes after administration and last approximately four to six hours. Some residual
effects can be found 12 hours or more after administration.

Flunitrazepam causes partial amnesia; individuals are unable to remember certain events
that they experienced while under the influence of the drug. This effect is particularly
dangerous when flunitrazepam is used to aid in the commission of sexual assault; victims may not be
able to clearly recall the assault, the assailant, or the events surrounding the assault.

It is difficult to estimate just how many flunitrazepam-facilitated rapes have occurred in
the United States. Very often, biological samples are taken from the victim at a time when
the effects of the drug have already passed and only residual amounts remain in the body
fluids. These residual amounts are difficult, if not impossible, to detect using standard screening
assays available in the United States. If flunitrazepam exposure is to be detected at all, urine
samples need to be collected within 72 hours and subjected to sensitive analytical tests. The problem
is compounded by the onset of amnesia after ingestion of the drug, which causes the victim to
be uncertain about the facts surrounding the rape. This uncertainty may lead to critical delays
or even reluctance to report the rape and to provide appropriate biological samples for
toxicology testing.

While flunitrazepam has become widely known for its use as a date-rape drug, it is
abused more frequently for other reasons. It is abused by high school students, college students,
street gang members, rave party attendees, and heroin and cocaine abusers to produce
profound intoxication, boost the high of heroin, and modulate the effects of cocaine.

Flunitrazepam is usually consumed orally, is often combined with alcohol, and is abused
by crushing tablets and snorting the powder.

Flunitrazepam abuse causes a number of adverse effects in the abuser, including
drowsiness, dizziness, loss of motor control, lack of coordination, slurred speech, confusion, and
gastrointestinal disturbances, lasting 12 or more hours. Higher doses produce respiratory
depression. Chronic use of flunitrazepam can result in physical dependence and the appearance
of withdrawal syndrome when the drug is discontinued. Flunitrazepam impairs cognitive
and psychomotor functions affecting reaction time and driving skill. The use of this drug in
combination with alcohol is a particular concern as both substances potentiate each other's toxicity.

v Inhalants

Sniffing
an inhalant-soaked
rag from a bag is a form
of "huffing."

Inhalants are a chemically diverse group of psychoactive
substances composed of organic solvents and volatile
substances commonly found in more than 1,000 common household
products, such as glues, hair spray, air fresheners, lighter fluid, and
paint products. While not regulated under the Controlled
Substances Act, many states have placed restrictions on the sale of
these products to minors.

Inhalants may be sniffed directly from an open container
or "huffed" from a rag soaked in the substance and held to the
face. Alternatively, the open container or soaked rag can be placed in a bag where the
vapors concentrate before being inhaled. Although inhalant abusers may prefer one particular
substance because of the odor or taste, a variety of substances may be used because of
their similar effects, availability, and cost. Once inhaled, the extensive capillary surface of the
lungs allows rapid absorption of the substance, and blood levels peak rapidly. Entry into the brain
is so fast that the effects of inhalation can resemble the intensity of effects produced by
intravenous injection of other psychoactive drugs.

The effects of inhalant intoxication resemble those of alcohol inebriation _stimulation and
loss of inhibition, followed by depression. Users report distortion in perceptions of time and
space. Many users experience headache, nausea or vomiting, slurred speech, loss of motor
coordination, and wheezing. A characteristic "glue sniffer's rash" around the nose and mouth may
be seen. An odor of paint or solvents on clothes, skin, and breath is sometimes a sign of
inhalant abuse.

Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can
directly induce heart failure and death. They also cause death from suffocation by displacing oxygen
in the lungs and then in the central nervous system, causing breathing to cease. The chronic use
of inhalants has been associated with a number of serious, long-term, and often irreversible
health problems. These include hearing loss, brain and central nervous system damage, bone
marrow damage, liver and kidney damage, and blood oxygen depletion.

Inhalant abuse is shockingly common among children and adolescents. Inhalants are
readily available, inexpensive, and easy to conceal. Therefore, they are increasingly popular
with young people and are, for many, one of the first substances abused. The extent of the
inhalant problem among children and adolescents was, at first, virtually unrecognized by the
general public. However, a tragic event in early 1999 called national attention to this severe
problem. Five high school girls were killed in a car accident outside Philadelphia, and the
coroner's report showed that four of the five, including the driver, had ingested "significant" amounts of
a computer keyboard cleaner. Since this event, there has been an increased awareness of
the threat of inhalant abuse.
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